[Orthopod] Re: post-nailing fracture


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[Orthopod] Re: post-nailing fracture

drgauravbhalla2003 at yahoo
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Jan 29, 2008, 6:39 AM

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[Orthopod] Re: post-nailing fracture	Can't Post

This is a very nice discussion. If I may comment -
1. I feel that the option of exchanging this nail with a similar,
longer nail with multiplanar distal locking screws is the most
biologic option and the removal of this nail should not be much of a
problem.
2. The total time taken and the blood loss in this surgery should not
be more than the other 2 options, in fact if all goes well it may be
quicker as the approach is smaller and the closure will take lesser
time.
3. The only compromise over the locking plate is the purchase in the
distal fragment, but once the locking bolts are in place the purchase
should be enough for at least wheel chair mobility and isometric and
isotonic Quads.
4. The rehabilitation time and the knee stiffness should also be the
least with this method.
5. Bone healing (union) should be fast as it is a long spiral
metaphyseal-diaphyseal # and using this fixation the fracture site
will not be opened.
6. The screw in the neck will prevent (prophylactic fixation) a neck
fracture in this already osteopototic bone.
7. Of course medical management for osteoporosis must be initiated, I
do not consider any need for cement.
Thank you all.

On Jan 16, 9:17 pm, "reverberi sandro" <reverberisan...@gmail.com>
wrote:
> Dear All,
> I should like know what is your preferred treatment for this fracture at the
> tip of a long Gamma nail (on a healed subtrocantheric fracture : see img
> tmgn00a).
> The patient is a 81 years old lady with osteoporosis and important knee
> arthrosis (as you can see).
> Do you remove the nail or not? can we obtain a stable ostheosynthesis with a
> plate without remove the nail?
> Do you prefer to apply a plate or an endomedullary nail (along the old way
> of gamma nail) to preserve joint motion?
> It is justified to apply bone cement in the bone loss ?
> Best regards
> Sandro Reverberi
> Arcispedale S. Maria Nuova
> Reggio Emilia
> Italy
>
> tmgn3.jpg
> 74KViewDownload
>
> tmgn2.jpg
> 45KViewDownload
>
> tmgn00a.jpg
> 16KViewDownload
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